I had a massive toothache. I decided I needed to see a dentist. I didn’t have a regular dentist so went to what was called an emergency dentist. He said the tooth was too far gone and suggested I have the tooth extracted. I would do anything to get out of pain at that point so agreed. When he was done he said there was a hole in my sinuses from the cavity and put my on general antibiotics. He said it would heal on its own now that the tooth is extracted. But it’s been three months and I’ve had non-stop sinus infections ever since. My doctor has had me on antibiotics, but they never help. The hole is still there. Is it too late to get this repaired?

Jessica

Dear Jessica,

Before we get into your sinus perforation, I wanted to make sure you know that an emergency dentist is really just a general dentist who will treat non-established patients quickly in the case of a dental emergency. They’re not a specialist of any kind.

It is unlikely the cavity caused the hole in your sinuses. It’s much more likely the dentist perforated your sinuses during the extraction. This isn’t that unusual. However, there is a protocol he should have followed which seems to have been missed. By this point, if the hole was going to heal on its own it would have by now.

The fact that it hasn’t tells me there are likely some bone fragments from the extraction in your sinus cavity that needs to be removed. In your place, I’d see and ENT. Let them know what is going on when you call to schedule and they’ll get you in sooner than normal.

Avoiding Dental Emergencies

You’ve been through some pretty bad trauma with your recent dental visit. As you already weren’t comfortable going to the dentist I feel I can safely assume you’ve had some trauma in the past as well. When that happens it usually causes dental anxiety. This can keep you away from the dentist.

I don’t want that to happen to you. It only leads to more dental emergencies. One thing that can help you with this is going to a dentist who likes working with anxious patients. Many of them offer dental sedation which allows you to relax completely during your appointment. Most patients are so relaxed they prefer to sleep through their procedures.

I’m not sure what to do. My dentist gave me six injections in the same area trying to get me numb and it just wouldn’t work. I am in desperate need of a root canal treatment and am living on prescription pain killers which are really strong and addictive. They also make me a tad sleepy. Help me! Have you encountered this with any of your patients?

Bethany

Dear Bethany,

Dental anxiety is common, but there is a solution…the right dentist.

I think I know exactly what is going on here. It is very likely you are suffering from a level of dental anxiety. Some patients face this every time they are in the dental chair. For others, it may be the thought of a procedure which is giving them the jitters.

The problem this causes is with your metabolism. Anxiety raises your metabolism and other bodily functions, which in turn burns off the medication more quickly making it less effective. This is very likely why you are having trouble getting numb. If we can help with the anxiety, you’ll have no issues getting numb. Fortunately, there is a solution.

The Cure for Dental Anxiety

I’m going to suggest you see a dentist who is used to working with patients suffering from anxiety. These dentists often offer varying levels of dental sedation. I’ll tell you about the two most commonly offered and give you their pros and cons. You can decide which level will best suit your level of anxiety.

Nitrous Oxide

This is a simple nosepiece which you will use to breathe in the nitrous oxide. It is sometimes dubbed laughing gas, not because it makes you giggle, but it does give you a relaxed, floaty feeling. This eases your anxiety enough to allow your numbing medicine to take effect. It has the additional benefit of no long term effects. Once your procedure is over, the dentist will simply switch your gas to pure oxygen and you can get on with your day as normal.

Oral Conscious Sedation

This is for patients for more severe anxiety. You and your dentist will have to go over all medications you are currently taking to ensure there are no medicines which will interfere with one another. After that, it is a simple matter of you taking a pill the morning of your appointment. This is a super strong medication. As a result, you will need someone to drive you to and from your appointment. You’ll still be groggy, so you’ll want them to stay with you until you are lucid again. Though, no matter how strong your anxiety, this will relax you. In fact, most patients sleep through their entire appointment.

How do you know if something is a dental emergency? My boyfriend has had trouble eating. I asked him about it and he said his wisdom teeth are acting up again. I peeked at it. It looks like one of them is only partly out and is very swollen. He swears it is fine and always goes away after a while. But, I’m worried. What should I tell him?

Cassie H.

Dear Cassie,

Dear Cassie,

I’m sorry your boyfriend is in pain. It sounds like he may have an impacted wisdom tooth. If it is partially in and partially out, there’s likely a little flap where things, like food and other bacteria can get trapped.

There’s likely something trapped there now which is why he’s in pain. These type of things can turn into an infection quickly. If he’s having trouble eating, it’s likely an infection now. This is a dental emergency.

Dental infections aren’t like other infections where you can take an antibiotic and that’s that. While an antibiotic can slow down the infection, a dentist has to go in and physically remove any infected pulp.

Should Impacted Wisdom Teeth Be Removed?

It’s not always necessary to remove impacted wisdom teeth. However, his are a consistent problem for him. It’s much safer to have them removed when he is in his late teens to early twenties. Beyond that the surgery gets riskier.

Most dentist will do wisdom tooth extractions without him having to see a separate oral surgeon. They’ll just use dental sedation. However, he will be loopy and will need someone to drive him to and from the appointment as well as stay with him until he’s lucid again.

If he doesn’t currently have a dentist, he’ll need to call around to find a dentist who treats non-established patients in cases of emergencies. You can often find them doing an internet search for an “Emergency Dentist“.

Just be sure to check their reviews to make sure people have had good experiences with them.

My son is almost 16. My husband thinks he should be going to an adult dentist. But, the pediatric dentist really caters to him and makes him comfortable. I’m afraid an adult dentist wouldn’t be as friendly. But, my husband is worried we’re coddling him. What’s the normal age a child should leave a pediatric dentist?

Paula M.

Dear Paula,

No matter how old our children get, they will always be our children. I bet when you look at your almost 16-year-old you still see a little boy. As to a normal age, there isn’t one. Every child is different and each pediatric clinic has their own policy.

If you’re concerned about the transition, there are some ways to make this go simpler.

Another thing to consider is whether or not they offer sedation dentistry. Some procedures are more frightening than others, even for brave male adolescents. Because of that, you’ll want the option of giving your son the most comforting and relaxing option for treatment.

Do make sure you check their reviews though. You want to make sure those who’ve been to their office have come away with positive experiences.

Benefits to using a General Dentist

As your son gets older, his dental needs change. I’m assuming he’s responsible for his own oral health care at this point in his life. If not, he should be. But, even at his age, many boys tend to neglect their oral care.

If he gets to a point where he needs a root canal or a dental crown, you want a dentist with a great deal of experience performing those procedures.

Additionally, he’s getting close to the age where wisdom teeth can become an issue. That’s more a general dentist/oral surgeon procedure.

I hope this helps. I know your husband is anxious he not stay child-like and you may have trouble seeing him as anything but your little boy. Finding a general dentist who meets the above requirements is a way to bring both of you peace, while ensuring your son gets the best care possible.

We have a new baby, which I know can be challenging to a budget, but I really think my husband needs to see a dentist. He’s had a toothache. We have only been married for two years, but in all that time he’s never gone to the dentist. At first, he blamed our new expenses for getting a house. Then he blamed the cost of pre-natal appointments. Now the expense of being parents. I’m beginning to think he’s afraid of the dentist and is just using money as an excuse. How can I get him to the dentist?

Ceanne L.

Dear Ceanne,

Fear of the Dentist is Common

It’s possible that both anxieties are real. There’s a lot of pressure in providing for a family and most men feel the weight of the world come down upon them the first time they hold that baby. All of a sudden it’s real.

As for dental anxiety, he’s certainly not alone. Many Americans feel the exact same way. There’s a way to help him with both. Let’s deal with the fear of the dentist first.

There are dentists who are compassionate and understand the fear some patients have. For many, it started with a childhood trauma. Maybe he had an insensitive dentist who was rough with him as a child. That fear can be quite visceral.

What he needs is a dentist who understands and will work with his fear. They’re patient and don’t judge patients or lecture them about how long it’s been since they’ve been to the dentist.

Sedation is Sometimes Necessary

For some patients, the fear is so strong that their metabolism speeds up and burns off any local anesthetic. That makes the situation even worse because they can’t get numb when necessary. In those type of cases, we’ve found oral conscious sedation to do wonders.

They simply take a pill before their appointment. It completely relaxes them. In fact, it will relax him so much that he’ll need you to drive him to and from the appointment, as well as stay with him throughout the day. He’ll be a little unsteady on his feet.

Financial Anxiety

Most dentists are more than willing to work with you. They’ll allow you to pay off the treatment a little at a time, as long as you talk to them about it ahead of time. If, for some reason, you run up against not being able to find a sedation dentist who’s willing to work with you, Care Credit is a fantastic option. It’s a medical card that allows you to pay off your bill. Depending on your credit, you can even get zero percent interest.

My husband has this red sore in his mouth with white around it. If I took him to an emergency dentist would they evaluate it? I’m worried it’s something dangerous like cancer. But he doesn’t have a dentist. He won’t admit this, but he’s afraid of them. I’ll have to convince him to go, even though he’s in pain, so any advice you have for that would be helpful too.

Stacey

Dear Stacey,

I’m glad you wrote because I think I can help you. First, as to your husband’s sore. Most likely it is a canker sore. They’re quite painful and look a bit like you’ve described. Most of the time they go away in three weeks. If it hasn’t by then, it would be time to see a dentist. You wouldn’t necessarily need an emergency dentist but if he doesn’t have a dentist of his own that may be his only option. With regular check-ups, his dentist would have been doing regular screenings for oral cancer.

Helping Fearful Patients Avoid Dental Emergencies

Your husband isn’t the only person who avoids the dentist because of anxiety. But, if he doesn’t start going he could end up with a serious dental emergency—one that could be life-threatening. There is a solution that has changed the lives of many fearful patients.

I’d suggest you look for a dentist who also offers sedation dentistry. This will completely relax your husband during his dental procedures. In fact, most patients sleep through the procedure. If he uses oral conscious sedation, which is what I’d recommend in his case, he’ll need someone to stay with him throughout the day because he’ll be a bit woozy.

I took my son to the dentist for his check up. I was shocked that he needed two fillings. Even though he brushes his own teeth, I always brush them after. I know they’re thoroughly brushed. But, he showed me the cavities on the x-rays. So, I agree to get them filled. But, I do tell him I’ll only do the white fillings. It’s important to me not to intentionally put toxins in his body. He agreed. But every time he placed them, within a week they’d fall out. We’ve had them replaced twice now. Is this normal? Should I go to a different dentist?

Lucy M.

Dear Lucy,

It’s commendable that you take your son’s oral hygiene so seriously. It’s obvious your diligent with his care. Don’t feel too bad about the cavities. You can do everything right and cavities can still develop.

No, it’s not normal for white composite fillings to fall out, especially more than once. I’m wondering if your dentist has a lot of experience placing white fillings, especially on children. Composite fillings require a different bonding technique than the older silver fillings. He may not be used to the technique. It’s even trickier with children because the filling has to stay completely dry while it’s being placed. If any moisture gets in, it could compromise the bond. That’s likely what’s happening with your son.

You have a couple of options. One is to switch dentists. There are plenty of pediatric dentists who are used to placing white fillings. There are even general dentists who enjoy treating children that are a mercury free office.

Another option is to stay with this dentist but see if he offers some form of sedation dentistry. This would be a good option if you think the problem is moisture and your son is wiggly (which is common with children and not a deficiency in your son). When children use dental sedation they often fall asleep during the procedure. This enables the dentist to work more efficiently.

Truthfully, even a pediatric dentist might suggest sedation in some form in order to do the white fillings.

My doctor prescribes me Xanax for when I’m anxious, which I am quite a bit. The dental chair throws me for quite a loop though. I’ve made it a point to go more regularly, but I’m afraid it’s been so long that I’ll need a lot of scary work. Can I take Xanax before going or is that a no-no?

Lyric A.

Dear Lyric,

It’s great you’re making more of an effort to get to the dentist despite your anxiety. To me, that says you’re a braver woman than you likely consider yourself. It takes tremendous courage to face things that frighten you. You’re also smart. Too many patients wait until they have a dental emergency to go to the dentist, which leads to much more serious and difficult procedures. You’re being proactive, which will make your stint at the dentist much easier.

You’re likely safe taking your Xanax before your dental appointment. Just be certain your dentist knows what you’ve taken so he adjusts any medication he needs to give you to be compatible with what you’re taking. However, I want to tell you about a dental service that may make taking Xanax unnecessary for you.

However, there is a procedure which would preclude you from even needing to take your Xanax. Many dentists who cater to anxious patients use something called dental sedation. This is a simple pill you’ll take before your appointment. It completely relaxes you. In fact, most patients sleep through their appointment. One thing to be aware of is that you will need someone to drive you to and from your appointment. You’ll be a little woozy and unsteady on your feet. You don’t want to risk a fall.

Patients with dental anxiety that use this method have found that it completely changes the way they view the dentist. They no longer dread going. Another benefit is the ability to get more work done in one sitting. So, if you do find you need a little extra work because you’re just now getting back to the dentist, you may be able to get it all done in one appointment while you nap.

I hope this helps put your mind at ease.
This blog is brought to you by Dr. Steve Murphree.

I struggle to pay for dental care for my children, but I do get them to the dentist. They don’t seem to care that it’s hard for me to pay for just the normal stuff and keep adding things. X-rays every six months, sealants, and then they told me she’d have to have nitrous oxide to do the sealants. I know none of those things are extremely expensive, but added up it means I can barely afford food this month. Then three of the sealants fall off between appointments and they tell me we have to re-do it at OUR cost. Shouldn’t they help with this seeing as their sealants fell off?

MaryAnne L.

Dear MaryAnne,

There are a few things I’d like you to ask about, which could help your situation with your pediatric dentist. First, is x-rays. Though many dentists do them every six months, the standard is once a year. Unless there’s a clinical reason for doing them more often, which there sometimes is, then requesting just once a year is reasonable. If your daughter is at high risk for cavities because of genetics or a certain type of medication she’s on or if they’re keeping an eye on some cavities then doing them twice a year is probably necessary. Catching things early will save you money and your daughter unnecessary and painful procedures.

Next is the nitrous oxide. That is completely unnecessary for dental sealants. It’s useful in procedures that can be high stress for children, such as getting a filling, but sealants are basically just painted on. It’s completely pain-free. You are allowed to refuse the nitrous. It seems unnecessary to me to add that cost.

Next is the sealants themselves. They are actually very useful and will save your daughter from getting cavities on vulnerable teeth, especially her molars which have deep grooves and pits in them. But, they shouldn’t be falling off. The exception would be if she eats a lot of sticky candy and food. They could pull up young sealants.

If you’re having trouble getting explanations and cooperation you don’t have to take your daughter to a pediatric dentist. There are plenty of general dentists who love and are equipped to treat children. You could check with them as possibilities. Talk to your dentist first explaining our concerns. At the least, they should offer to do the sealants without charge the second time.

I am terrified of the dentist. Absolutely terrified. I have to go because I’m pretty sure there’s something wrong with my tooth. I thought if I could drink a few glasses of wine I’d be relaxed enough and could pull off this appointment.

Lexie G.

Dear Lexie,

You’re not alone in your fear of the dentist. Many Americans feel that way. You’re doing the right thing by going to the dentist even though you’re afraid. That says a lot about your sound judgment. You don’t want this to blow up into a dental emergency. Many patients don’t realize how serious dental infections can get. In fact, just this past February a thirty-something year old father of two died from waiting too long to get his tooth looked at. Once the infection spreads to your bloodstream or brain, it’s life-threatening.

Though I wouldn’t recommend drinking wine, I do have a solution for you. Wine isn’t a solution on the off-chance you’ll need some type of medication that the alcohol will interfere with. You don’t want to limit your dentist’s ability to help you.

Instead of wine, I’d recommend you try sedation dentistry. This will completely change the way you view dental care. The sedation relaxes you. Most patients end up sleeping through the entire appointment. The benefit is there’s no chance of any interaction with medication the dentist may need to give you. So, you’ll be able to take care of your tooth infection without any fear or pain.